HEALTH REIMBURSEMENT ARRANGEMENTS
Client Information Form and Administration Guide
For: (Client Name)
Table of Contents
Client Information Form ......................................................................................................................................................... 3
Health Reimbursement Arrangement (HRA) Implementation Form ...................................................................................... 5
HRA Plan Designs .................................................................................................................................................................... 8
Standard Plan Design Options................................................................................................................................... 8
Custom HRA Plan Design* ...................................................................................................................................... 10
Enrollment Method............................................................................................................................................................... 12
Health Reimbursement (HRA) Administration Guide ........................................................................................................... 14
Timing of Claim Payments................................................................................................................................... 14
Claim Adjustments Received on Carrier Claims Feed ......................................................................................... 15
Non-Discrimination Testing ................................................................................................................................ 15
Funding Process .................................................................................................................................................................... 16
Overview ................................................................................................................................................................. 16
Claims Funding and Maintenance Deposit ......................................................................................................... 16
Check Information............................................................................................................................................... 16
Unclaimed Checks ............................................................................................................................................... 16
Funding Reports .................................................................................................................................................................... 17
Division Subtotals ................................................................................................................................................ 17
Enrollment and Eligibility ...................................................................................................................................................... 17
Initial Enrollment Census .................................................................................................................................... 17
Ongoing Eligibility Method.................................................................................................................................. 17
Carrier Feed Enrollment ...................................................................................................................................... 17
Plan Specifics ......................................................................................................................................................................... 18
Participant Pay .................................................................................................................................................... 18
Provider Pay ........................................................................................................................................................ 18
Explanation of Plan Design Option Components: ................................................................................................................. 19
Employer Reports.................................................................................................................................................... 20
Employer Portal ...................................................................................................................................................... 20
Users and Access Levels .......................................................................................................................................... 20
Participant Communications ................................................................................................................................................. 21
Participant Forms .................................................................................................................................................... 21
Health Reimbursement Arrangement Reimbursement Form: ........................................................................... 21
Direct Deposit Authorization Form: .................................................................................................................... 21
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Client Information Form
Client Information
Client’s Legal Name:
Client's DBA or AKA Name:
Mailing Address:
Physical Address:
Main Phone Number:
Tax ID:
Tax Year End Month and Day:
Total Number of Employees:
State Organized:
Entity Type(C-Corp, S-Corp, etc.):
Controlled Group?
If yes, list Affiliates including Tax ID#:
Click here to enter text.
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Fax Number:
Click here to enter text.
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Number of Benefit Eligible:
Industry: Click here to enter text.
Click here to enter text.
Yes
No
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Point of Contact Information
Signing Authority Contact
Primary Contact for HRA?
Name:
Title:
Email Address:
Telephone:
Primary Client Contact
Secondary Client Contact
Broker Contact
Yes
No
Yes
No
Yes
No
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Employer Portal Access?
Name:
Title:
Email Address:
Telephone:
No
Click here to enter text.
Employer Portal Access?
Name:
Title:
Email Address:
Telephone:
Yes
Click here to enter text.
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Employer Portal Access?
Name: Click here to enter text.
Agency: Click here to enter text.
Email Address: Click here to enter text.
Telephone: Click here to enter text.
Broker will be copied on all implementation, renewal and escalated emails
Check this box if broker should not be copied on these emails:
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Finance Contact
Name:
Title:
Email Address:
Telephone:
Employer Portal Access?
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Yes
No
Meeting/Benefit Fair Attendance and Employee Handouts
Do you need Benefit Strategies
Yes
representation for a Benefit Fair,
employee meeting or webinar*? If yes, list the dates, times, locations:
Click here to enter text.
Click here to enter text.
No
Click here to enter text.
*Please note, Representation is based on first come first serve and BSL requires 2 weeks notice to attend.
BSL will send an electronic version of standard handouts to the client point of contact.
Are hard copies also needed*?
Yes
No
*Please note, additional fees may apply. If yes, list how many, by what date, who to send to:
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Plan Information
Current BSL Service(s):
Click here to enter text.
New BSL Plan(s) to Implement:
Click here to enter text.
Do you have an Existing HRA:
Yes
BSL Effective Date(s):
Click here to enter text.
Plan Year (ex. January 1 – December 31):
Click here to enter text.
Running Short Plan Year?:
Number of Projected Participants:
No
Yes
No
Click here to enter text.
Takeover
Are you requesting a takeover implementation?
What is the current plan year end date?
Will the takeover plan year and the new plan year
requirements be the same?
Yes - continue below
No
Click here to enter text.
Yes
No*
*If no, include the current summary plan description
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Divisions
Do you need Divisions set up for reporting or billing
purposes?
If yes, list Divisions:
(BSL will need to know who belongs in each division)
Yes
No
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Health Reimbursement Arrangement (HRA) Implementation Form
Eligibility Information
Do you offer group health insurance to HRA Eligible employees?
Who is your Medical Carrier?
Waiting period for new eligible employees:
Yes
No
Click here to enter text.
Date of Hire
1st of month following date of hire
1st of month following 30 days
Other (cannot exceed 90 days)
When does coverage end after employee
termination?
Date of Event
End of Month
Other:
Click here to enter text.
A self-employed individual, partner or person who owns more than 2% of the outstanding
stock of the company is not eligible for HRA enrollment.
If this applies to your organization, are these HRA-ineligible people
enrolled in the health plan coverage that goes with the HRA?
Yes
No
If yes, please provide us with the list of the individuals so BSL
can flag them as ineligible: Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Non-Discrimination Testing
Will you be using the BSL non-discrimination testing service for
this plan?
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Yes
No
Plan Document
Benefit Strategies provides new plan document:
Plan Name:
Plan Number:
Use standard naming convention (Client Name HRA Plan Document)
Other Name: Click here to enter text.
Use standard Plan number: 502
Other Number:
Click here to enter text.
Benefit Strategies provides re-stated plan document:
Effective date of current plan document:
Click here to enter text.
Name of current plan document:
Click here to enter text.
Current Plan Number :
Click here to enter text.
Benefit Strategies is not responsible for the plan document.
Benefit Strategies is not responsible for the Summary Plan Description (SPD).
Will HRA eligible employees also be offered a Health Savings
Account (HSA)?
Yes
No
If yes, will they be able to be enrolled in both the HRA and HSA?
Yes
No
Will HRA eligible employees also be offered a Flexible Spending
Account (FSA)?
Yes
No
Yes
No
Yes
No
Will the employer allow an employee to drop employer health
coverage when the employee experiences a reduction of hours
(mid-year) and still maintain eligibility in the group health plan?
May an employee who experiences a mid-year qualifying event
be permitted to drop group health plan coverage in order to
obtain coverage through the Marketplace?
List the names of all medical plans tied to the HRA:
Click here to enter text.
Click here to enter text.
Click here to enter text.
Please note: Summaries and/or SBCs are required for all
plans. Click here to enter text.
Will domestic partners be eligible for the HRA?
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Yes
No
The final day of the month of the Dependent’s 26
birthday
When does a covered
dependent age off the plan?
The end of the calendar year of the Dependent’s 26
birthday
Other:
HRA Reimbursement Method:
#1: Carrier Claims Feed
BCBSMA
Anthem ME
Anthem NH
Tufts
HPHC
NHP
Aetna*
*please note: additional
fees may apply
Are you aware of how repayments are handled if the carrier adjusts a claim
that results in the HRA having overpaid?
Yes
No
Who will receive payment?
Participant Pay
Provider Pay**
** Not eligible with
Anthem ME or Anthem NH
If Provider Pay:
Please confirm awareness of the MA Health Safety Net Surcharge.
Yes
No
Please confirm awareness of our incomplete billing address
Yes
No
process.
List all medical plan group numbers and/or sub group numbers that are ineligible
for the HRA:
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
#2:
Participant Submission
#3:
Debit Card Submission:*
Rx Only
*debit card option only available for non-complex HRA
plan designs
213d expenses
Would you like a custom logo for the Debit Card?*
*please note, additional fees may apply
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Yes
No
HRA Plan Designs
Clients have the option of 3 standard HRA plan designs to choose from. In addition, clients
with 500 or more benefit eligible employees can instead choose a custom plan design.
Standard Plan Design Options:
Eligible Expenses: Medical plan deductible expenses
HRA Pays: Choose one of the below:
HRA Pays First: 50%
Participant Responsibility: Second 50% of medical plan
deductible expenses
HRA Responsibility: First 50% of medical plan deductible
expenses
HRA Pays Second: 50%
Participant Responsibility: First 50% of medical plan
deductible expenses
HRA Responsibility: Second 50% of medical plan deductible
expenses
Option 1 No per person maximum.
If the HRA pays
Option 2 Per person maximum, any
second, please combination can meet the family responsibility.
choose:
Option 3 Per person max, two family
(Click or hover over the members must meet their per person
plan types for more responsibility.
information)
Option 4 Strict per person maximum.
HRA Pays First: 100%*
*Subject to carrier rules. Please contact your carrier rep to confirm eligibility and
forward the confirmation to BSL.
Participant Responsibility: None
HRA Responsibility: 100% of medical plan deductible
expenses
Whole amount available on first
HRA Funds Available:
day of plan year
Whole amount available on
HRA Funds Available for Mid-Year Adds:
participant effective date
Run-out Period After Plan Year Ends: 90 days
Run-out Period For Participants Terminated From Plan: 90-days from termination date
HRA Funds Rollover: No
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Deductible Information
Deductible runs:
Plan Year
Calendar Year*
*If Calendar Year, what is your medical policy year renewal? Click here to enter text.
Deductible Amounts:
Single: $Click here to enter text.
2-Person: $Click here to enter text.
Family: $Click here to enter text.
Are prescriptions subject to deductible?
Yes
No
Can any number of family members combine to meet the
Yes
No
family deductible?
Is there a per person deductible limit for Family
Yes
No
coverage?
If yes, what is the amount? $Click here to enter text.
Does the medical plan have a 4th quarter deductible
carryover provision?
If yes, whose responsibility will the carryover funds
reduce?
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Yes
No
Participant
HRA
Custom HRA Plan Design*
*(Only available for clients with 500 or more benefit eligible)
Responsible for first portion of
deductible:
Participant
HRA
There is no per person maximum on the deductible.
One family member or a combination of family members
must meet the full participant responsibility before the HRA
will pay any claims.
If the HRA pays second, please
choose:
There is a per person maximum on the deductible. Each
family member must meet the full per person responsibility
before the HRA will pay any claims for that family member.
In addition, once any combination of family members has
met the full family responsibility, the HRA will begin paying
for all family members.
There is a per person maximum on the deductible. Each
family member must meet the full per person responsibility
before the HRA will pay any claims for that family member.
In addition, once two family members have met the per
person responsibility, the HRA will begin paying for all
family members.
There is a strict per person maximum on the
deductible. Each family member must meet the per person
responsibility before the HRA will pay any claims for that
family member.
Other - Please explain:
(ie: multiple tiers, percentage of claim paid, etc.)
Click here to enter text.
Will the HRA reimburse expenses other than the deductible?
Yes
No
Are prescriptions subject to deductible?
Yes
No
Eligible Expenses:
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Click here to enter text.
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Click here to enter text.
Click here to enter text.
Click here to enter text.
Single: $Click here to enter text.
2-Person: $Click here to enter text.
Family: $Click here to enter text.
Participant Responsibility:
Single: $Click here to enter text.
2-Person: $Click here to enter text.
Family: $Click here to enter text.
HRA Responsibility:
NOTE: Verify with your carrier that your HRA
plan design is permitted to be paired with the
medical plan(s)
Is there a per member maximum
reimbursement amount?
No
Yes, Amount:
$Click here to enter text.
Click here to enter text.
HRA Funds Available:
Choose an item.
Click here to enter text.
Click here to enter text.
Whole amount up front
HRA Funds Available for Mid-Year Adds:
Pro-rated:
Monthly: Eligible in month of hire?
No
Yes, regardless of effective date
Yes if effective date is on or before 15th
of month
Quarterly
Defined After Date:
Pro-ration will start on:
Click here to enter text.
Participant will receive
$
Run-out Period After Plan Year Ends:
90 days
Other: Click here to enter text.
90 days from termination date
Run-out Period For Participants Terminated From Plan:
Other*: Click here to enter text.
*please note, fees will apply
Rollover of HRA Funds:
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No
Yes, provide specifics:
Choose an item.
Click here to enter text.
Choose an item.
Click here to enter text.
Enrollment Method
How will we receive the initial enrollment information?
Benefit Strategies file spec will be completed and sent
From Vendor
From Client
Client direct entry in administrator portal
Carrier Eligibility File*:
HPHC
NHP
*Please note that enrollment information will not be received for 7-10 business days after the plan effective date.
Ongoing Eligibility
How will we be receiving on-going eligibility? (Additions, Terminations, Changes)
Claims feed clients, please check this box as on-going eligibility will be sent to
Benefit Strategies from your carrier:
HPHC
NHP
Tufts* (new and changes, no terms)
Client direct entry in administrator portal
Benefit Strategies file spec will be completed and sent
From Vendor
From Client
Frequency:
Click here to enter text.
File Contact Name:
Click here to enter text.
File Contact Phone:
Click here to enter text.
File Contact Email:
Click here to enter text.
FTP Address:
Click here to enter text.
HRA Continuation Coverage Information
Is your company subject to FMLA?
Is your company subject to COBRA?
Are you aware that HRAs are COBRA eligible plans and that
the HRA needs to be a separate COBRA election?
Is COBRA administration handled in-house, by Benefit
Strategies, or other?
If other administrator:
Name:
Address:
Telephone:
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Yes
Yes
No
No
Yes
No
Choose an item.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Fees
Set Up Fee:
Renewal Fee:
Plan Takeover Fee:
Monthly Admin Fee and Minimum
Monthly Invoiced Amount:
Initial Card Fees:
Replacement/Additional Card Fees:
Non-Discrimination Testing Per Plan
Per Test (done upon request):
Claims Funding Invoicing Method:
Fee Invoicing Method:
Maintenance Deposit Information:
Special Notes:
$Click here to enter text.
$Click here to enter text.
$Click here to enter text.
$Click here to enter text.
$Click here to enter text.
$Click here to enter text.
$Click here to enter text.
Invoiced To:
Invoiced To:
Invoiced To:
Invoiced To:
Invoiced To:
Invoiced To:
Invoiced To:
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Click here to enter text.
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Notes
Click here to enter text.
Please only return pages 3-13 to Benefit Strategies when completed. The remaining pages are
yours to keep as a reference guide.
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Health Reimbursement (HRA) Administration Guide
Timing of
Claim
Payments For
Participant
Submitted
Claims
Timing of
Claim
Payments For
Claims
Received on
Carrier Claims
Feed
Eligible
Expenses
Claim
Requirements
for Participant
Submitted
Claims
Mailed or faxed claims are scanned and queued for processing within 1-3 business days of
receipt. Claims uploaded to the consumer portal are immediately available for processing.
Claims are typically approved or denied within 2-4 business days.
Notifications for denied claims and for claims where more information is required are sent
for claims processed the prior day.

Check and direct deposit files are created three times per week for claims approved as
of the prior business day.

Checks are mailed next day.

Direct deposits are posted same day and available to participants within 1-2 business
days after files are loaded.
Most carriers send a weekly claims feed. The timing of claims that are captured on the
weekly feed varies based on the carrier’s processes. Once the feed is received at Benefit
Strategies, claims are processed within 3-5 business days.

Check (whether to participant or provider) and direct deposit files are created three
times per week for claims approved as of the prior business day.

Checks are mailed next day.

Direct deposits are posted same day and available to participants within 1-2 business
days after files are loaded.
Clients determine eligible expenses as a part of the plan design.
Claims may be filed through the participant’s online portal, the Benefit Strategies mobile
app, or by submitting a paper claim form via secure email, fax or mail. Certain HRA plan
designs may not be compatible with online or mobile filing.
Claims must include only expenses eligible for reimbursement as defined by the HRA plan
design.
Documentation supporting the claim must be included with each claim filed that indicates
the claim was for an eligible expense. The carrier’s Explanation of Benefits (EOB) or
Activity Summary (must provide the below information) provides the best information.





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Patient or dependent name
Date of service
Description of service
Expenses incurred
Indication of how the expense matches the HRA plan design (for example an
indication that the expense was subject to the deductible)
Claim
Adjustments
Received on
Carrier Claims
Feed
Occasionally, a medical plan claim is adjusted at a later date by the insurance carrier. The
carrier will notify the participant, the provider and Benefit Strategies of the adjustment. If
the adjustment results in the HRA needing to pay out additional dollars, BSL will process
the additional payment.
If the adjustment results in the HRA having overpaid, Benefit Strategies will send you a
Repayment Request Form to the participant as they will need to reimburse the HRA for
the overpayment.
Note: If the participant has paid the provider in full for the original claim, once the
provider processes the carrier adjustment a credit should show on the patient account
for the claim. The participant may need to contact the provider to arrange for the
credit to be sent to them. Unlike medical carriers, Benefit Strategies does not have a
business relationship with the providers. Instead, Benefit Strategies is simply mailing a
payment to the provider on the patient’s behalf. Due to patient privacy laws,
providers typically will not speak with Benefit Strategies about a patient account and
will not send a credit on an account directly to Benefit Strategies.
NonNon-discrimination testing is available upon request and subject to a fee. Upon request,
Discrimination the client is sent information and forms to complete, including providing census
information on all employees.
Testing
Administering
Run Out From
Current TPA
Takeover From
Current TPA
HRA Takeover
Template.xlsx
If an HRA is already in place and you are changing administration to Benefit Strategies
with the start of the new plan year, the outgoing administrator should handle the
outgoing plan year run-out.
A takeover implementation means Benefit Strategies will take over the administration of
your current plan year. Because BSL will have taken over the administration mid-year, BSL
will then handle the run-out at plan year end.
Takeovers can be done at any point in the plan year, up to 31 days prior to the plan year
end date. Example: If plan year ends December 31, takeover must happen December 1 or
earlier.
Typically, the outgoing administrator will want a claim filing black out period so all inhouse claims can be settled and final balances provided to Benefit Strategies.
Benefit Strategies must be provided with the following information using the attached
template in order to do a takeover:
• Enrollment Census
• Current Balances
• Claim History (if this can’t be provided, BSL is unable to prevent a claim previously paid
by the prior TPA from being submitted to Benefit Strategies and paid out again.)
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Funding Process
Overview
Benefit Strategies pays claims three times per week. Claims are paid in advance and clients are
invoiced weekly for claims paid the prior week.
Claims Funding
and
Maintenance
Deposit
Please complete
the Claims Funding
Agreement and
EFT Form (if
applicable) and
return with this
document.
Funding Agreement
All Forms.pdf
Check
Information
Sample Participant
Pay Check.pdf

Checks and direct deposit payments are drawn against a Benefit Strategies, LLC bank
account.

Check and direct deposit files are created three times per week for claims approved
as of the prior business day and sent to fulfillment.

A Claims Funding Request report (invoice for claims paid) is emailed to clients weekly
for the prior week’s claims reimbursements.

Funding amounts are due within 2 business days after receipt of the funding request.
Payment is made to Benefit Strategies, LLC either by check (Manual Invoice), ACH
payment, or EFT debit.

A Maintenance Deposit is required to mitigate the risk of Benefit Strategies paying
claims in advance. The Maintenance Deposit is determined by looking at the total
HRA exposure and multiplying that amount by 40% to arrive at estimated utilization.
BSL will then divide that by 26 to arrive at two weeks worth of anticipated utilization.

The Maintenance Deposit amount is revisited only when a new plan is added or a
current plan is dropped, or there is a significant change in enrollment.

The Maintenance Deposit is returned at the time the service is no longer offered.

A brief explanation is included with each claim payment check.
The participant pay check includes more information on accounts and current year
balances whereas the provider pay check only includes payment details for that
provider’s payment.

Participants may contact Customer Service to request a claim payment check be
voided and reissued if the check is lost and has not yet been cashed.

All claim payment checks indicate “Void after 180 Days”.
o In our experience, banks will still cash checks after the 180 days
Sample Provider Pay
Check.pdf
Unclaimed
Checks
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
Clients will address the escheatment and/or other handling of unclaimed checks that
have reached the 180 day expiration date.

A report of unclaimed checks will be provided upon request.
Funding Reports
A claims funding invoice and claims funding report will be emailed weekly to the financial contact(s) you
indicated on the Client Information Form. The invoice provides notification of the amount required for
funding claims paid the prior week as well as any adjustments, and debit card fees (if applicable). The report
provides the details to support the invoice.
Division
Subtotals
Funding invoices and/or reports will contain divisional subtotals if applicable.
Sample Claims HRA
Funding Invoice.pdf
Sample Claims
Sample Claims
Funding Invoice by Division.pdf
Funding Invoice Detail by Division HRA.xlsx
Enrollment and Eligibility
Initial
Enrollment
Census
Enrollment
Template.xls
The attached census should be used to provide Benefit Strategies, LLC with
HRA enrollment information.
Enrollment information is due to Benefit Strategies, LLC by the below time
frame:
January effective dates: No later than December 1st.
All other months: At least 20 days prior to the plan start date.
Ongoing
Eligibility
Method
IMPORTANT: Testing needs to be completed with Benefit Strategies prior
to the Go Live date. Vendors sending files often require a long lead time.
Please send the eligibility file spec to your vendor immediately, and
confirm their ability to comply with the testing timeline. For additional
details on eligibility file testing or specifications, please contact
BSL Universal
Eligibility Template - HRA.xlsx
[email protected] for assistance.
Per ACA requirements, a stand alone HRA for medical expenses is not
permitted. It must be attached to a group medical plan.
BSL HRA Dependents
File Specification.xls
Carrier Feed
Enrollment
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Harvard Pilgrim - Full eligibility sent can be used for initial enrollment and
mid year additions and changes
Neighborhood Health Plan - Full eligibility sent can be used for initial
enrollment and mid year additions and changes
Tufts - Partial eligibility sent, which is used for mid year additions and
changes. Terminations will need to be communicated as well as a initial
file to start the year
Anthem NH - no eligibility
Anthem ME - no eligibility
Plan Specifics
Email plan summaries for all medical plans tied to the HRA.
Health Reimbursement Arrangement Payments Made to Domestic Partners
Health
Reimbursement Arrangement Payments Made to Domestic Partners.pdf
Participant Pay
When carrier processes a claim adjustment that results in the HRA having overpaid,
participant is responsible for sending the overpayment to Benefit Strategies.
Provider Pay (not available on Anthem feeds)
Please be aware of the following for Provider Pay Option:
HRA_COMASS-Healt
MA Health Safety Net Surcharge of 1.86% of claim amount for claims paid to MA
h-Safety-Net-Surcharge-and-Provider-Pay-Information.pdf
Acute Care Hospitals and Ambulatory Surgical Centers
When carrier processes a claim adjustment that results in the HRA having overpaid,
participant is responsible for contacting their provider to receive the overpayment
and forwarding it to Benefit Strategies.
When the carrier claims feed has an incomplete or missing provider address,
HRA Reimbursement
Methods.pdf
payment will be made in participant’s name and mailed to participant home
address.
HRAs and HSAs
Employees can’t have access to reimbursement funds through an HRA and become or
remain HSA-eligible unless the HRA is a Post-Deductible HRA. In this case, the HRA
doesn’t begin to reimburse any deductible expenses until the employee has incurred
at least the required minimum deductible limits. In 2017, the required minimum
deductible $1,300 for single coverage and $2,600 for family coverage.
A Post-Deductible HRA allows employees to remain HSA-eligible while the employer
picks up some or all of any cost-sharing (deductibles and coinsurance, if applicable)
above the required thresholds ($1,300/$2,600 in 2017.)
The Post-Deductible HRA also doesn’t impact contributions limits. Employees can still
contribute up to the statutory maximum to their HSAs ($3,400 (single coverage or
$6,750 family coverage in 2017), plus an additional $1,000 catch-up contribution if
they’re age 55 or older. Note that HSA contributions limits are from all sources,
including any employer contributions. Employers can, but aren’t required to,
contribute to employees’ HSAs. Some generous employers contribute enough to
cover much or, in some extreme cases, all of the employees’ deductible responsibility
before the Post-Deductible HRA begins to reimburse claims.
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Explanation of Plan Design Option Components:
Eligible Expenses:
The expenses that will be eligible for reimbursed under the HRA.
Participant Responsibility:
The amount the HRA participant is responsible for paying on the eligible expense; this can be a percentage of
the expense category, a flat dollar amount or a percentage of each eligible claim.
Examples for a $1000 deductible plan:
Percentage: The participant is responsible for 50% of the deductible
Flat Dollar: The participant is responsible for $600 of the deductible
Percentage of Claim: The participant is responsible 50% of each eligible claim.
HRA Responsibility:
The amount the HRA is responsible for paying on the eligible expense.
HRA Funds Available:
The schedule of when HRA funds will be available for reimbursements during the plan year. Most common is
to have the full amount available on the first day of the plan year.
HRA Funds Available for Mid-Year Adds:
Whether the total HRA responsibility will be available for a mid-year add or if it will be a pro-rated amount.
Run-out Period After Plan Year Ends:
Number of days after plan year end date in which claims incurred in the prior plan year can be submitted
and/or received on claims feed.
Run-out Period For Participants Terminated From Plan:
Number of days after a participant’s termination date in which claims incurred in the prior plan year can be
submitted and/or received on claims feed.
HRA Funds Rollover:
Refers to whether all, a portion or none of the unused HRA funds rollover to the next plan year.
HRA Plan Grouping:
Refers to plan year versus calendar year deductible.
Please review the attachment and return with plan design if applicable:
HRA Medical CY
versus PY.docx
Plan Documents:
New Plan Document - a new plan that you do not currently offer.
Re-state Plan Document – a plan that is currently in place and Benefit Strategies will be the new administer of
said plan.
(Back to standard plan design)
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(Back to custom plan design)
Employer Reports
Account Balance Report:
Plan
Management
Reports
Account Balance
Report Sample.pdf
Enrollment Report:
Enrollment Report
Sample.pdf
Reports are scheduled to run on a monthly basis.
Reports are posted on the Employer Portal for access by Employer Portal users with reporting
permission.
Reports will be provided in an MS Excel format when this option is available, but a PDF may be
requested instead if this format is required.
Employer Portal
Users and
Access Levels
Employer Portal
User Roles.pdf
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An email will be sent to each employer portal contact with information
regarding use of the Employer Portal and log in credentials.
Participant Communications
HRA participants include employees, COBRA participants, or terminated employees still within their run out
period.
Email notifications are sent to active participants with an email address when the letters below are generated.
The email notification informs the participant the associated letter is available for viewing via the Consumer
Portal.
Spending Account Self Service Notifications
Notice Type
Email Sample
Mail Sample
Claim Denial Emailed Notification
and Mailed Notification
HRA sample denial w
repayment-ptp.pdf
Claim Denial with Repayment
Required
Advice of Deposit for Claim
Reimbursement (emailed only)
Denial Letter Email
Sample.pdf
Denial Letter with
Repayment Email Sample.pdf
Advice of Deposit
Email Sample.pdf
Sample Request for
Repayment - Mailed.pdf
N/A
Participant Forms
HRA Self Service Forms – all forms are located on www.benstrat.com under the HRA tab as well as within the
employer and employee portals.
Health Reimbursement Arrangement
Reimbursement Form:
Not used for clients on claims feed.
HRA Claim Form.pdf
Used for participants to submit for reimbursement from their
HRA via a paper form.
Direct Deposit Authorization Form:
Direct Deposit
Authorization Form.pdf
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Used if direct deposit account information is faxed or mailed
instead of being entered directly in the Consumer Portal.